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Psychiatry > Schizo, Paranoia, BPD, Schizoaffective > Flashcards

Schizo, Paranoia, BPD, Schizoaffective Flashcards

1
Q

Schizophrenia - categories of symptoms

A

Cluster of symptoms that fall into two major categories

  1. Positive - reflect exaggerated or distorted normal functions
  2. Negative - reflect reduced normal functions
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2
Q

What are the positive symptoms of Schizophrenia.

A
  1. Delusions
  2. Hallucinations
  3. Disorganised speech
  4. Grossly disorganised or catatonic behaviour

Schizophrenic patient must show at least 1 month long psychotic episode exhibiting positive symptoms

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3
Q

Negative symptoms of schizophrenia

A
  • Prodromal symptoms often precede the psychotic episode and the residual symptoms may follow it.
  • Duration must be 6 months
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4
Q

Positive symptoms. Delusions

A
  • Exaggerated or distorted interferential thinking
  • Persecutory delusions are the most common
  • Bizzare delusions are characteristic of Schizophrenia
  • Delusions are deemed bizzare if they are implausible, not understandable and do not derive from ordinary life experiences - example: internal organs replaced without scars
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5
Q

Hallucinations in Schizophrenia

A
  • Exaggerated or distorted perceptions occur in any sensory modality (aud, visual, olfactory, gustatory, tactile)
  • Auditory hallucinations are most common
  • Voices conversing with one another, commentary on person’s thoughts
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6
Q

Disorganised speech in Schizophrenia

A
  • Exaggerated or distorted language) - Person may slip off the track from one topic to another
  • Answers to questions are completely unrelated or obliquely related
  • Rarely speech may be severely disorganised that it is nearly incomprehensible (incoherence)
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7
Q

Disorganised behaviour in Schizphrenia

A
  • Exaggerated or distorted behaviour
  • Problems with goal directed behaviour leading to difficulties in performing activities of daily living such as organising meal or maintaining hygiene.
  • person may dress inappropriately - wearing coats on hot day
  • Inappropriate sexual behaviour - public wanking
  • Unpredictable and untriggered agitation (e.g. shouting, swearing), catatonic behaviour
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8
Q

Attenuated positive symptoms in Schizophrenia

A
  • Mild/sub threshold positive symptoms frequent in prodromal and residual periods of psychotic episode.
  • Patients express unusual beliefs (ideas of ref or magical thinking)
  • Do not reach intensity of delusions
  • They sense presence of unseen person or force
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9
Q

Types of negative symptoms

A
  1. Affective blunting or flattening
  2. Alogia
  3. Avolition
  4. Anhedonia
  5. Asociality

Negative symptoms can persist between psychotic episodes and reduce social and occupational functioning in the absence of positive symptoms

They aren’t as dramatic as positive symptoms but they are more treatment resistant

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10
Q
  1. Affective blunting or flattening. Negative
A
  • Reduced emotional experience and expression
    E.g. feels numb, empty inside

Apathetic, exhibits restricted eye contact, facial expressions and body language

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11
Q
  1. Alogia. Negative
A
  • Reduced thought and speech

- Impaired verbal fluency; impoverished content of speech, words covey little meaning. E.g. talks less and few words

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12
Q
  1. Avolition. Negative
A
  • Reduced desire, drive and motivation to pursue goal-directed behaviour
  • lack of spontaneity, reduced ability to initiate, persist and complete everyday task
  • spend most time in bed, engage in no hobbies
  • lack interest in eating even
  • poor grooming and hygiene
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13
Q
  1. Anhedonia. Negative
A
  • Reduced ability to experience pleasure e.g. loss of interest in previously pleasurable hobbies or interests.
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14
Q
  1. Asociality. Negative
A
  • Reduced social drive and interaction
  • Social withdraws
  • less talkative and inquisitive
  • shows reduced desire to initiate and maintain social contacts, has no friends or close relationships
  • little interest in social activities, sex, spending time with friends.
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15
Q

Other types of symptoms in Schizophrenia

A
  1. Cognitive
  2. Aggressive
  3. Affective symptoms
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16
Q

Affective symptoms

A
  • Depression
  • Anxiety
  • Worry
  • Dysphoria
  • Anger
  • Guilt
  • Tension
  • Phobias

Occur in Prodromal, psychotic and residual period

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17
Q

Aggressive and hostile symptoms.

A
  • Argumentativeness
  • Verbal or physical abuse
  • Frank violence and assault
  • impulsiveness
  • Self injurious behaviours - suicide attempt, property damage
18
Q

Cognitive symptoms

A
  • Impairment in sensory and information processing
  • Focusing and sustaining attention
  • Working memory
  • Abstract thinking and problem solving
  • language function

Important to treat these because they correlate with others - negative

19
Q

Stages of Schizophrenia

A

Stage 1

Stage 2

Stage 3

Stage 4

20
Q

Stage 1 of Schizophrenia

A
  • Has full or nearly full functioning early in life and virtually asymptomatic
  • Although on closer inspection some insight motor, language, affective and social impairment and soft neurological signs may be detected
  • Onset may be abrupt but it is usually insidious with a prodromal stage
21
Q

Stage 2 of Schizophrenia

A
  • Starts in teens with gradual development of social withdrawal, loss of interest in school or work
  • deterioration of hygiene and grooming, odd behaviours
  • Subtle negative symptoms, irritability, depressive symptoms and impaired cognition
22
Q

Stage 3

A
  • acute stage
  • Manifests itself fairly dramatically in twenties with psychotic episode
  • Course is recurrent psychotic episodes and remissions
  • With negative symptoms persisting between episodes and becoming steadily more prominent.
  • each episode with prodromal and followed by residual phase.
  • Downhill course, patient never returns back to previous levels of functioning
23
Q

Stage 4 of Schizophrenia

A
  • Final residual stage may begin in the forties
  • with prominent negative and cognitive symptoms
  • More of a “burn-out” stage of continuing severe disability and progressive resistance to antipsychotics.
24
Q

Treatment

A
  1. Biological therapy
  2. Electroconvulsive therapy
  3. Psychotherapy
  4. Sociotherapy/Psychosocial rehabilitation
25
Q

Biological therapy q

A
  • Atypical antipsychotics (clozapine, olanzapine, quetiapine, risperidone, paliperidone, aripiprazole) are drugs of choice for treatment of both psychotic episodes (positive symptoms) and
  • long-term maintenance treatment for prevention of psychotic relapses
  • Their effect on negative and cognitive symptoms is unsatisfactory
  • in non-responding cases typical antipsychotics may be tried (haloperidol, flupentixol, fluphenazine)
  • Clozapine for treatment resistant Schizophrenia
26
Q

Electroconvulsive therapy (ECT)

A
  • Not first line treatment and other psychosis
  • Main indication for ECT is severe psychotic episodes, catatonia, severe schizoaffective syndromes, treatment resistance and malignant neuroleptic syndrome
  • ECT is not effective for negative symptoms
27
Q

Psychotherapy

A
  • Cognitive behavioural, humanistic and family psychotherapy are applied successfully
  • Always in combination with biological therapy
28
Q

Sociotherapy/Psychosocial rehabilitation

A
  • Therapeutic societies
  • Patients’ organisations
  • Social support
  • Education and support for families
  • Social skills training
  • Vocational (occupation) therapy
29
Q

Delusional disorder (paranoia)

A

The individual has usually non-bizzare delusion(s) but without the other positive (hallucinations, disorganised speech etc) and negative symptoms of Schizophrenia

Duration must be at least 1 month

30
Q

What are the themes of delusional disorder (Paranoia)

A
  1. Erotomanic type - Central theme is another person in love
  2. Grandiose type - Inflated worth. great but unrecognised talent. Made discover
  3. Jealous type - Lover unfaithful
  4. Persecutory type - He/she is being malevolently treated, conspired against, cheated, spied on
  5. Somatic type - Bodily functions or sensations. E.g. Individual emits a foul odour, infestations on skin, internal parasite

MOST FREQUENT TYPE: Persecutory

31
Q

Functional consequences of delusional disorder.

A
  • There is normality of their behaviours and appearance and preserved social and occupational roles when their delusional ideas are not being discussed or acted upon.
  • Social, marital or work problems can result from delusional beliefs.
  • Some develop depression, dysphoria, irritability, anger and violent behaviour and
  • an understandable reaction of the individual to the rejection of their beliefs by the community
32
Q

Differential diagnosis of paranoia (delusional disorder)

A
  • Schizophrenia can be distinguished from delusional disorder by the presence of other positive and negative symptoms
  • In depressive/bipolar disorders and schizoaffective disorder delusions occur exclusively during mood episodes
33
Q

Brief psychotic disorder (BPD)

A
  • Individual has sudden onset (change from non-psych state to a full set of psychotic symptoms, usually in response to marked stressors (e.g. loss of loved one, combat stress)
  • Individual experiences emotional turmoil, overwhelming confusion and rapid shifts from one intense affect to another
34
Q

Set of symptoms in BPD

A
  • Delusions
  • Hallucinations
  • Disorganised speech
  • Grossly disorganised or catatonic behaviour
35
Q

Prognosis and duration of BPD

A
  • Psychosis is brief but the level of impairment can be severe and supervision may be required to ensure that nutritional and hygienic needs are met
  • And ensure that individual is protected from consequences of poor judgement, cognitive impairment, risk of suicide, acting on basis of delusions
  • SEVERAL DAYS TO MONTH with eventual full return to the premorbid level of functioning despite relapses.
36
Q

Differential diagnosis of BPD

A

Other psychosis with short duration of action

  • Substance misuse/medication induced
  • Other conditions such as Schizo, Delusional disorders and depressive/bipolar disorder with psychotic symptoms are long term disorders and their symptoms are for more than a month
37
Q

Schizoaffective disorder

A

Patient combines both schizophrenic and affective symptoms concurrently

  • Individual exhibits positive symptoms of schizophrenia (psychosis) predominately in the context of depressive or manic episodes
  • Individual exhibits sometimes psychosis outside depressive or manic episodes but on the whole the depressive or manic episodes predominate over the psychotic episodes during the lifetime duration of the illness.
38
Q

Prognosis of Schizoaffective disorder

A
  • Usually better than for Schizophrenia but its worse than the prognosis for mood disorders.
39
Q

Functional consequences of Schizoaffective disorder

A
  • Risidual and negative symptoms are usually severe and less chronic than seen in Schizo
  • There may be impaired occupational and social functioning, restricted social contact, difficulties with self-care but not always and not as much as in schizo
40
Q

DD of Schizoaffective disorder

A
  • Depressive/bipolar disorder with psychotic symptoms, in contracts to schizoaffective disorder, do not exhibit symptoms outside of the depressive or manic episodes
41
Q

Comorbidity of Schizoaffective disorder

A
  • Often co-occur with anxiety, alcohol an other substance use disorders
  • There is increased risk of suicide, mainly due to the presence of depressive symptoms.

Psychiatry (7 decks)

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